Health

Kentucky Governor Matt Bevin is again proposing changes to the Medicaid waiver still awaiting approval by the federal government. The changes are aimed at decreasing what the state will have to pay to run the program, but would make it a little harder for people to keep their Medicaid coverage.

Former Governor Steve Beshear originally expanded Kentucky’s Medicaid program to include people making up to 138 percent of the poverty limit after the Affordable Care Act passed in 2010, setting up a funding stream for states to expand.

Bevin ran on dismantling that Medicaid expansion before his election in 2015, citing the high costs. Last summer, he submitted a plan to the federal government outlining a truncated version of both Medicaid and Medicaid expansion.

The state estimates that its newest changes, announced Monday, would cause an additional 9,000 Kentuckians to lose Medicaid insurance. That’s in addition to the approximately 90,000 people that are predicted to lose coverage under Bevin’s original waiver. The state also estimates the move would save an additional $27 million over the next five years.

Dustin Pugel with the Kentucky Center for Economic Policy said most of the original changes to the Medicaid program involved a lot of government tracking. But he said Bevin’s newest changes put the responsibility of staying insured more on Medicaid enrollees versus the state.

“I think they’re trying to create less administrative burden for themselves,” Pugel said.

Instead, these changes rely on enrollees reporting their income and employment hours, “which would ultimately end in more people losing coverage,” Pugel said.

Here’s a look at the two major changes in the proposal.

Bevin’s Original Waiver Bevin’s New Waiver Proposal
Community Engagement
Medicaid enrollees will not have have a work or volunteer requirement at first sign-up. At three months, however, people not working 20 hours a week would have to volunteer, take a GED class or do job training. After being on Medicaid for six months, that requirement would increase to 10 hours a week; after nine months, it would increase to 15 hours a week; at one year, it would increase to 20 hours a week. Medicaid enrollees will have to work at least 20 hours a week at the start of enrollment. If you don’t work, you have to volunteer, take GED classes or take job training.
The state’s logic: “Tracking these hour increases by each member’s unique set of circumstances and variable factors will be challenging for both IT systems and member communications.” People receiving food assistance through SNAP and housing or financial services through the Temporary Assistance for Needy Families have this work/volunteer requirement already.
If you haven’t had Medicaid coverage for the previous five years, you get a three-month grace period for this requirement. If you’ve had Medicaid for three months or more for the past five years, you’ll go straight into the requirement.
Six-month lockout period for failing to re-enroll every month
Every month, Medicaid enrollees will have to submit ‘redetermination paperwork’ including : income and employment hours to prove their eligibility and determine how much they pay every month. Medicaid enrollees won’t have to submit income and employment information every month. Instead, enrollees will have 10 days to submit income changes or adding/subtracting work hours.
If enrollees don’t submit that and the state finds out, enrollees will be locked out of coverage for six months.

These changes don’t apply for pregnant women, children under 19, ‘medically frail,’ people, primary caregivers of a dependent and full-time students.

Among the things that haven’t changed in Bevin’s proposal is that Medicaid enrollees (minus pregnant women and the four other groups of people listed above) will all have monthly payments, called premiums, no matter how small their income.

As an alternative to that monthly premium, enrollees will be able to pay a fixed amount every time they see the doctor.

And the cost of collecting and managing these premiums is likely going to be high.

Arkansas has a similar model with monthly premiums. A recent study from the University of Arkansas for Medical Sciences found around 50,000 people had to make these payments of between $10 and $15 a month. The state contract to collect and manage these payments cost over $9 million.

Bevin’s proposed changes don’t require a new round of public hearings, but state officials are holding them anyway on July 14 in Somerset and July 17 in Frankfort. People can also submit their comments until August 2 at midnight either in writing or submit via email to kyhealth@ky.gov.

Lisa Gillespie is WFPL's Health and Innovation Reporter.